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June 21, 2017

A day in the life: surgery

I've been racking my brains as to what to post lately. I've just been working and going out to dinner with friends, and blogging about dinner is getting a bit boring. So I figured I'd post about work, where I'm currently doing a rotation as an intern* in a certain surgical specialty.


Staff toilet selfie.

5.15am My alarm goes off. It's really cold.

5.30am I roll out of bed. I usually like to have a sit down breakfast in the morning, but today after washing my face and doing my eyebrows I only have time to scoff down a banana and throw a muesli bar into my bag.

6.30am I arrive at the hospital. The resident and I get in early to look at the details of the new admissions overnight, make sure all the rights tests have been ordered for them, and update our team's list of patients (which is on a clunky spreadsheet). Our list isn't too long today.

7.00am The registrars arrive and we go through the list to make sure we're all on the same page about the patients. We then start the classic quick-fire surgical ward round. I have to duck out at the beginning to put an IVC into an anxious pre-op patient who has needle phobia and didn't want the med students (who usually help out with these) to place it. I pretend to be more confident than I actually am, and get it in first go while he swears at me. I then rejoin the ward round.

8.15am We probably set a new record by finishing the round so quickly. Our team goes for coffee, which our reg kindly buys (the most important tradition). They only have time for a quick re-group before they head to the operating theatre. The resident, med students and I chill out for a little longer, and I catch up with the jobs that I missed when I was away from the round.

8.30am The resident and I head back to the ward to get started on jobs for the day. There are a few semi-urgent transfers to a larger hospital, where patients can get treatments they can't at ours, so we make sure the paperwork is done and things are moving. A patient's haemoglobin has come back very low, so a blood transfusion needs to be organised for him. There's also a bunch of paperwork to sort out. I eat my muesli bar.

9.30am The emergency buzzer goes off. Usually it's a false alarm, but this time one of our patients has fainted in her chair. I arrive embarrassingly slowly. When I get there, she's awake and seems okay. I ask her some questions and examine her. The nurses check her vital signs and do an ECG, which are fine. The patient's blood results from that morning look good. I quickly look up causes of syncope to make sure I've thought of everything... a blood sugar level! It's normal. There are no red flags so I'm pretty happy it wasn't a sign of something serious. I order some more tests to run on her bloods. I then sit down and document everything that happened in her notes.

10.30am I have a quick look through the blood test results from the morning, to make sure all the patients have enough red blood cells, that their kidneys and livers are doing okay, and that infections are resolving. Usually in the morning we also call for consults, which is when you call other medical teams to review medical issues your team isn't specialised in; e.g. the cardiology team for a patient with chest pain. I hate doing this, as there's always a chance the registrar on the other end will get snippy with you - you're giving them more work, after all. Luckily there are none to do today.

11.00am At this time every day there's a ward meeting with the nurse in charge, allied health (physiotherapists, occupational therapists and social worker), and the junior doctors from each team. We go through all our patients to work out what needs to be done to get them home. This hospital's been bed-blocked almost every day since I started two months ago - there's a lot of pressure to discharge patients.

11.20am The resident stays on the ward, while I go to preadmissions clinic to see people coming in for elective surgeries. I'm only there to give patients forms for blood tests and make sure their medications are charted. While I'm in clinic I get a page; it's the microbiology consultant calling me about results that show a patient has a serious infection, which means his operation will need to be done more urgently. I call the resident, who's been ducking in an out of theatres to touch base with the registrars, and he lets them know.

12.30pm I finish with clinic. I head up to the common room where there is a free sponsored lunch. They're sad looking sandwiches, but hey, they're free. I eat three.

1.00pm I go back to the ward and catch up with the resident. He's pretty frustrated - he's been caught up in a "shoot the messenger" type of situation, which is pretty commonplace for us as junior doctors. By the sounds of it, he handled it much better than I would have. We then do miscellaneous jobs, like charting meds, putting in IVCs, writing scripts and med certificates, and read what allied health and other medical teams have written in the notes for our patients.

2.00pm After the morning flurry of activity, it's quietened down. The resident and I are can go to theatre and scrub in when we want, as long as the ward is under control (sometimes it feels like a Cinderella "you can only go to the ball once you've finished this impossible list of tasks" situation), but neither of us is very interested in the procedure that's happening. I order blood tests to be done on our patients tomorrow morning (a morning pathology nurse comes round and does them). We try and teach the med student some things to help her with upcoming exams. The resident is an aspiring anaesthetist and knows a lot about pain and nausea medications; I learn as well.

3.30pm I'm rostered on a short day today, which means I can leave now. This rotation's been good in that we finish relatively on time. The resident and I alternate between long and short days; the person on the long day sticks around until the registrars finish operating for the end-of-day paper round, and does whatever jobs that come out of that. On long days we leave at about 5.30 to 6pm.

* Intern = first year doctor, resident = second year doctor. We do general rotations around the hospital system and do the same jobs on the team. Registrar = more senior doctors who are training in a particular specialty. As a surgical team, our registrars spend most of the day in the operating theatre. Consultant = qualified specialist ("attending" in America).

This was a pretty average day; not as busy as it gets, but not as relaxed either. I wish I did one of these posts back in my first term, although that one would've been barely coherent. I think I'll do one per rotation/type of shift, it might be interesting to look back on. I'm moving on again soon - as soon as I started settling in! I'm on relief next term, which means I'm doing a bunch of evening, weekend and night shifts, which will make for some interesting posts.

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